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Hadisuwarno W, Rahmawati LD. An Indonesian female with severe cutaneous lupus erythematosus: A case report and literature review. Int J Surg Case Rep 2023; 107:108336. [PMID: 37230060 DOI: 10.1016/j.ijscr.2023.108336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Cutaneous lupus erythematosus (CLE) is one of the most common symptoms in systemic lupus erythematosus (SLE) cases. SLE manifestations in the skin area seem to significantly affect the patient's quality of life, which is this condition for unmarried females. CASE PRESENTATION An Indonesian female, 23 years old, complained of skin peeling on her scalp, upper and lower extremities. The condition of the wound was severe in the head area. A biopsy was performed, revealing pustular psoriasis. She received immunosuppressant agent and wound care over the lesion. The patient showed good improvement after 2 weeks of this treatment. DISCUSSION Diagnosis of CLE through history taking, skin examination and histopathological findings. Since immunosuppressant agent is the primary therapy of CLE, monitoring is required because immunosuppressive drugs increase the risks of infection. The outcome of CLE treatment is to minimize complications and improve the patient's quality of life. CONCLUSION CLE primarily affects women, therefore early management, monitoring and collaboration with other departments will improve the patient's quality of life and increase their compliance with medication.
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Affiliation(s)
- Wiharjo Hadisuwarno
- Study Program of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Lita Diah Rahmawati
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
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Keshavamurthy C, Fibeger E, Virata A, Bansal P. Successful treatment of bullous lupus with corticosteroids and belimumab: A case report. Mod Rheumatol Case Rep 2023; 7:52-56. [PMID: 35538618 DOI: 10.1093/mrcr/rxac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 01/07/2023]
Abstract
Cutaneous lupus erythematosus (CLE) is one of the most common manifestations of systemic lupus erythematosus (SLE), although it can manifest as an independent entity as well. Bullous systemic lupus erythematosus (BSLE) is a rare cutaneous manifestation of SLE presenting as tense vesiculobullous eruptions in a photosensitive distribution. Pathophysiology is secondary to autoantibodies against noncollagenous domain 1 and 2 (NC1 and NC2) type VII collagen, and histopathology reveals dense neutrophilic infiltration of the dermis with direct immunofluorescence showing IgG deposition at dermoepidermal junction. There is lack of data on available therapeutic options to treat BSLE, and varying responses to dapsone, methotrexate, azathioprine and corticosteroids have been reported. Belimumab, a fully humanised Change to Immunoglobulin G1λ (IgG1λ) monoclonal antibody targeting soluble B lymphocyte stimulator protein, was the first Food and Drug Administration-approved drug for SLE and has been reported to be effective for CLE. We present the case of a 41-year-old black female with SLE presenting with BSLE, who was successfully treated with corticosteroids and belimumab and did not experience disease relapse even after discontinuation of corticosteroids. To our knowledge, this is the first reported case of successful treatment of BSLE with belimumab, and further research can help determine the role of belimumab in the treatment of BSLE.
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Affiliation(s)
| | - Emily Fibeger
- Department of Dermatology, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Andrew Virata
- Department of Dermatopathology, Tareen Dermatology, Roseville, MN, USA
| | - Pankaj Bansal
- Department of Rheumatology, Mayo Clinic Health System, Eau Claire, WI, USA
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3
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Anderson SR, Hynan LS, Chong BF. Late-onset cutaneous lupus erythematosus patients have distinctive clinical features and demographics versus early-onset patients. Lupus 2022; 31:1523-1528. [PMID: 35995793 DOI: 10.1177/09612033221122254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cutaneous lupus erythematosus (CLE) can present later in life, but frequency and risk factors of late-onset CLE patients are not well characterized. The study determined frequency of late-onset CLE and compared the demographic and disease characteristics between early-onset and late-onset CLE in a cohort of patients with CLE. OBJECTIVES To determine the frequency and compare clinical features of early-onset and late-onset CLE. METHODS This was a cross-sectional study of CLE patients seen in outpatient dermatology clinics at University of Texas Southwestern Medical Center (UTSW) and Parkland Health and Hospital System, Dallas, TX, from April 2009 to May 2019. The primary outcome was the age of CLE onset, stratified by early-onset (<50 years) and late-onset CLE (≥50 years). Predictor variables significantly associated with CLE onset groups were identified by univariate and multivariable logistic regression analyses. RESULTS Of the 291 CLE patients studied, 79% were early-onset, and 21% were late-onset. Multivariable logistic regression analyses identified that Caucasian race (odds ratio (OR): 2.23, 95% Confidence Interval (CI): 1.19-4.19, p = 0.013), having a CLE subtype other than chronic (OR: 2.18, 95% CI: 1.02-4.65, p = 0.044), and drug-induced cases (OR: 4.65, 95% CI: 1.18-18.24, p = 0.028) were significantly associated with late-onset CLE. Early-onset CLE patients were more likely to have oral ulcers (OR: 3.58, 95% CI: 1.46-8.78, p = 0.005) and renal disorders (OR: 4.02, 95% CI: 1.10-14.71, p = 0.036). LIMITATIONS This was a single center study. Age of onset was self-reported and late-onset CLE cohort has a small sample size. CONCLUSIONS Our diverse cohort of CLE patients had about one out of five patients with CLE experiencing disease onset after 50 years old. These patients have distinct demographic and clinical presentations compared to early-onset CLE patients. Providers should remain mindful of CLE in older patients with photosensitive rashes and mild systemic symptoms.
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Affiliation(s)
- Scott R Anderson
- John T. Milliken Department of Medicine, 12275Washington University School of Medicine, St Louis, MO, USA
| | - Linda S Hynan
- Departments of Population and Data Sciences & Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Bolduc C, Sperling LC, Shapiro J. Primary cicatricial alopecia: Lymphocytic primary cicatricial alopecias, including chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome. J Am Acad Dermatol 2017; 75:1081-1099. [PMID: 27846944 DOI: 10.1016/j.jaad.2014.09.058] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 12/19/2022]
Abstract
Both primary and secondary forms of cicatricial alopecia have been described. The hair follicles are the specific target of inflammation in primary cicatricial alopecias. Hair follicles are destroyed randomly with surrounding structures in secondary cicatricial alopecia. This 2-part continuing medical education article will review primary cicatricial alopecias according to the working classification suggested by the North American Hair Research Society. In this classification, the different entities are classified into 3 different groups according to their prominent inflammatory infiltrate (ie, lymphocytic, neutrophilic, and mixed). Part I discusses the following lymphocytic primary cicatricial alopecias: chronic cutaneous lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia, and Graham-Little syndrome.
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Affiliation(s)
- Chantal Bolduc
- Department of Dermatology, University of Montreal, Montreal, Quebec, Canada.
| | - Leonard C Sperling
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jerry Shapiro
- Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Dermatology, New York University, New York, New York
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5
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Pons-Estel GJ, Aspey LD, Bao G, Pons-Estel BA, Wojdyla D, Saurit V, Alvarellos A, Caeiro F, Haye Salinas MJ, Sato EI, Soriano ER, Costallat LTL, Neira O, Iglesias-Gamarra A, Reyes-Llerena G, Cardiel MH, Acevedo-Vásquez EM, Chacón-Díaz R, Drenkard C. Early discoid lupus erythematosus protects against renal disease in patients with systemic lupus erythematosus: longitudinal data from a large Latin American cohort. Lupus 2016; 26:73-83. [DOI: 10.1177/0961203316651740] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/04/2016] [Indexed: 01/13/2023]
Abstract
Objectives The objective of this study was to examine whether early discoid lupus erythematosus (DLE) would be a protective factor for further lupus nephritis in patients with systemic lupus erythematosus (SLE). Methods We studied SLE patients from GLADEL, an inception longitudinal cohort from nine Latin American countries. The main predictor was DLE onset, which was defined as physician-documented DLE at SLE diagnosis. The outcome was time from the diagnosis of SLE to new lupus nephritis. Univariate and multivariate survival analyses were conducted to examine the association of DLE onset with time to lupus nephritis. Results Among 845 GLADEL patients, 204 (24.1%) developed lupus nephritis after SLE diagnosis. Of them, 10 (4.9%) had DLE onset, compared to 83 (12.9%) in the group of 641 patients that remained free of lupus nephritis (hazard ratio 0.39; P = 0.0033). The cumulative proportion of lupus nephritis at 1 and 5 years since SLE diagnosis was 6% and 14%, respectively, in the DLE onset group, compared to 14% and 29% in those without DLE ( P = 0.0023). DLE onset was independently associated with a lower risk of lupus nephritis, after controlling for sociodemographic factors and disease severity at diagnosis (hazard ratio 0.38; 95% confidence interval 0.20–0.71). Conclusions Our data indicate that DLE onset reduces the risk of further lupus nephritis in patients with SLE, independently of other factors such as age, ethnicity, disease activity, and organ damage. These findings have relevant prognosis implications for SLE patients and their clinicians. Further studies are warranted to unravel the biological and environmental pathways associated with the protective role of DLE against renal disease in patients with SLE.
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Affiliation(s)
- G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Barcelona, Spain
| | - L D Aspey
- Department of Dermatology, Emory School of Medicine, Atlanta, USA
| | - G Bao
- Division of Rheumatology, Emory School of Medicine, Atlanta, USA
| | - B A Pons-Estel
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - D Wojdyla
- GLADEL Consultant, Universidad Nacional de Rosario, Rosario, Argentina
| | - V Saurit
- Servicio de Reumatología, Hospital Privado, Córdoba, Argentina
| | - A Alvarellos
- Servicio de Reumatología, Hospital Privado, Córdoba, Argentina
| | - F Caeiro
- Servicio de Reumatología, Hospital Privado, Córdoba, Argentina
| | | | - E I Sato
- Departamento de Medicina, Universidade Federal da São Paulo (UNIFESP), São Paulo, Brazil
| | - E R Soriano
- Sección de Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - L T L Costallat
- Divisao de Reumatologia, Universidade Estadual de Campinas, Campinas, Brazil
| | - O Neira
- Sección de Reumatología, Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - A Iglesias-Gamarra
- Facultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia
| | - G Reyes-Llerena
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba
| | - M H Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, México
| | - E M Acevedo-Vásquez
- Servicio de Reumatología, Hospital Nacional ‘Guillermo Almenara Irigoyen’, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - R Chacón-Díaz
- Servicio de Reumatología, Hospital Universitario, Caracas, Venezuela
| | - C Drenkard
- Division of Rheumatology, Emory School of Medicine, Atlanta, USA
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Timpane S, Brandling-Bennett H, Kristjansson AK. Autoimmune collagen vascular diseases: Kids are not just little people. Clin Dermatol 2016; 34:678-689. [PMID: 27968927 DOI: 10.1016/j.clindermatol.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Morphea, dermatomyositis (DM), and discoid lupus erythematosus (DLE) are autoimmune collagen vascular diseases that can present at any age. In all three of these diseases, the tenants of diagnosis and treatment are largely the same in both children and adults, with a few notable differences. Children with morphea are more likely to present with the linear subtype and have a higher incidence of extracutaneous manifestations. Children often need early aggressive systemic treatment to try to prevent long-term sequelae of morphea. In DM, adult disease has a clear association with malignancy that is not seen in children. Adults have a higher rate of pulmonary involvement and increased mortality, whereas calcinosis is more common in juvenile DM. DLE in adults is generally considered to have a low rate of progression from discoid lesions alone to systemic lupus erythematosus (SLE). DLE is less common in children, but several studies have suggested a higher rate of progression from DLE to SLE in children compared with adults.
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Affiliation(s)
- Sean Timpane
- Resident, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Heather Brandling-Bennett
- Assistant Professor, Department of Pediatrics, Division of Dermatology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Arni K Kristjansson
- Assistant Professor of Dermatology, University of Connecticut School of Medicine, Farmington, CT
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Hansen CB, Callen JP. Current and future treatment options for cutaneous lupus erythematosus. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1048224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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8
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Subacute cutaneous lupus erythematosus associated with lupus nephritis. APOLLO MEDICINE 2015. [DOI: 10.1016/j.apme.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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9
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Treatment of Bullous Systemic Lupus Erythematosus. J Immunol Res 2015; 2015:167064. [PMID: 26090480 PMCID: PMC4451988 DOI: 10.1155/2015/167064] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/21/2014] [Indexed: 01/22/2023] Open
Abstract
Bullous systemic lupus erythematosus (BSLE) is an autoantibody-mediated vesiculobullous disease in patients with SLE. Autoimmunity in BSLE is characterized by the presence of circulating anti-type VII collagen antibodies. BSLE patients often present with multiple, tense, clear fluid-filled vesicles and bullae overlying erythematous edematous plaques. Skin biopsy from BSLE patients shows subepidermal bullae with numerous neutrophils and only occasional eosinophils. Furthermore, immunofluorescence examination showed linear deposition of lgG, lgA, C3, and C1q along the basement membrane zone. BSLE patients with corticosteroids treatment constantly do not receive a marked improvement, while dapsone generally dramatically improved the skin condition. Recently, it has been reported that quite a few cases of BSLE were successfully treated with other immune suppressive drugs. Therefore, a comprehensive review of the treatment of BSLE would be beneficial to cure the disease.
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Saghafi M, Hashemzadeh K, Sedighi S, Yazdanpanah MJ, Rezaieyazdi Z, Sahebari M, Esmaily H. Evaluation of the Incidence of Discoid Lupus Erythematosus in Patients with Systemic Lupus Erythematosus and Its Relationship to Disease Activity. J Cutan Med Surg 2014; 18:316-9. [DOI: 10.2310/7750.2014.13122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with wide clinical features ranging from cutaneous manifestations to systemic disease. Skin is one of the most commonly affected organs in SLE. Objective: To determine whether there is any correlation between discoid lupus erythematosus (DLE) and the severity of SLE. Methods: In a prospective cross-sectional study, 60 consecutive patients with newly diagnosed SLE were enrolled. Skin biopsy was performed to establish the diagnosis of DLE. Disease activity was determined by the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K). A SLEDAI-2K score ≥ 10 was considered active and severe disease. Results: Eleven SLE patients (9 females and 2 males) had DLE (18.3%) and 49 patients (46 females and 3 males) had SLE without DLE (81.7%). The mean age of patients with DLE was 30.18 ± 11.07 years and in patients without it was 28.4 ± 10.26 years ( p = .6). Three of 11 patients with DLE (27.3%) and 14 of 49 patients without DLE (28.6%) had a SLEDAI-2K score ≥ 10 ( p = 1). Conclusion: The presence of DLE in our patients with SLE was not associated with less severe disease.
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Affiliation(s)
- Massoud Saghafi
- From the Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Ghaem Hospital; Department of Dermatology, Cutaneous Leishmaniasis Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; and Health Sciences Research Center, Department of Biostatistics and Epidemiology School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kamila Hashemzadeh
- From the Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Ghaem Hospital; Department of Dermatology, Cutaneous Leishmaniasis Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; and Health Sciences Research Center, Department of Biostatistics and Epidemiology School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sima Sedighi
- From the Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Ghaem Hospital; Department of Dermatology, Cutaneous Leishmaniasis Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; and Health Sciences Research Center, Department of Biostatistics and Epidemiology School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Javad Yazdanpanah
- From the Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Ghaem Hospital; Department of Dermatology, Cutaneous Leishmaniasis Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; and Health Sciences Research Center, Department of Biostatistics and Epidemiology School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Rezaieyazdi
- From the Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Ghaem Hospital; Department of Dermatology, Cutaneous Leishmaniasis Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; and Health Sciences Research Center, Department of Biostatistics and Epidemiology School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sahebari
- From the Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Ghaem Hospital; Department of Dermatology, Cutaneous Leishmaniasis Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; and Health Sciences Research Center, Department of Biostatistics and Epidemiology School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- From the Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Ghaem Hospital; Department of Dermatology, Cutaneous Leishmaniasis Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences; and Health Sciences Research Center, Department of Biostatistics and Epidemiology School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Kulkarni S, Kar S, Madke B, Krishnan A, Prasad K. A rare presentation of verrucous/hypertrophic lupus erythematosus: A variant of cutaneous LE. Indian Dermatol Online J 2014; 5:87-8. [PMID: 24616869 PMCID: PMC3937502 DOI: 10.4103/2229-5178.126048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sandeep Kulkarni
- Department of Skin and VD, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Sumit Kar
- Department of Skin and VD, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Bhushan Madke
- Department of Skin and VD, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Ajay Krishnan
- Department of Skin and VD, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Kameshwar Prasad
- Department of Skin and VD, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
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Site-specific analysis of inflammatory markers in discoid lupus erythematosus skin. ScientificWorldJournal 2014; 2014:925805. [PMID: 24744689 PMCID: PMC3972874 DOI: 10.1155/2014/925805] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 01/29/2014] [Indexed: 02/08/2023] Open
Abstract
Prior studies identified T cells, B cells, and macrophages in the inflammatory infiltrate and up-regulation of their protein products in discoid lupus erythematosus (DLE) skin; however, they lacked rigorous analyses to define their specific locations in skin. Thus, we compared expressions of selected T cell, B cell, and macrophage markers in five areas of DLE, psoriasis, and normal skin. Immunostainings for CD3, CD4, CD8, CD20, CD68, CXCR3, CXCL10, and TIA-1 were performed in biopsies of 23 DLE lesional skin, 11 psoriasis lesional skin, and 5 normal skin. Three independent observers used a graded scale to rate each marker's presence in the epidermis, dermatoepidermal junction (DEJ), perivascular area, periadnexal area, and deep dermis. DLE lesional skin contained an increased abundance of CD3+, CD8+, and CD68+ cells at the DEJ, and CD20+ and CD68+ cells in the periadnexal area versus psoriasis and normal skin. CXCR3, CXCL10, and TIA-1 were elevated in periadnexal sites of DLE lesional skin versus psoriasis lesional skin. The aggregation of T cells, B cells, macrophages, and their protein products (CXCR3, CXCL10, and TIA-1) in the DEJ and periadnexal area of DLE lesional skin may contribute to the pathology of DLE through a coordinated, sophisticated process.
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Lee ES. Skin and Rheumatic Disease. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.4.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Eun-So Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon, Korea
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14
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Systemic lupus erythematosus. Clin Immunol 2013. [DOI: 10.1016/b978-0-7234-3691-1.00064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Ghauri AJ, Valenzuela AA, O'Donnell B, Selva D, Madge SN. Periorbital Discoid Lupus Erythematosus. Ophthalmology 2012; 119:2193-2194.e11. [DOI: 10.1016/j.ophtha.2012.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/24/2012] [Indexed: 12/18/2022] Open
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16
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Musuruana JL, Cavallasca JA. A girl with cutaneous lesions, polyarthritis, and antinuclear antibodies positivity. ISRN DERMATOLOGY 2012; 2011:657673. [PMID: 22363856 PMCID: PMC3262532 DOI: 10.5402/2011/657673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/08/2011] [Indexed: 11/29/2022]
Abstract
On October 1996, a 14-year-old girl was admitted to the hospital because cutaneous lesions, asthenia, and arthralgias. On examination, there was nonscarring hair thinning with a widened part over the frontal hairline, polymorphic papulosquamous rash on her face, neck, arms, and trunk, and livedo reticularis in her legs. Multiple aphtous ulcers were present on the buccal and nasal mucosa. There was polyarthritis involving the wrist, metacarpophalangeal joints, proximal interphalangeal joints, and metatarsophalangeal joints of both hands and feet. Skin biopsy of the face was compatible with subacute cutaneous lupus erythematosus. She started on prednisone 60 mg/d without improvement, and later hdroxhchloroquine (HCQ) 6 mg/kg/d was added for one year. Cutaneous lesions were almost healed, with just a hypopigmented macules left. Over the last 14 years, she has not shown any cutaneous or systemic manifestations.
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Affiliation(s)
- Jorge L Musuruana
- Section of Rheumatology and Autoimmune Diseases, Hospital JB Iturraspe, Bv. Pellegrini 3551, 3000 Santa Fe, Argentina
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17
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Chong B, Song J, Olsen N. Determining risk factors for developing systemic lupus erythematosus in patients with discoid lupus erythematosus. Br J Dermatol 2011; 166:29-35. [DOI: 10.1111/j.1365-2133.2011.10610.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Treatment of non-renal lupus. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Obermoser G, Sontheimer RD, Zelger B. Overview of common, rare and atypical manifestations of cutaneous lupus erythematosus and histopathological correlates. Lupus 2010; 19:1050-70. [PMID: 20693199 DOI: 10.1177/0961203310370048] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The skin is the second most frequently affected organ system in lupus erythematosus. Although only very rarely life threatening--an example is lupus erythematosus-associated toxic epidermal necrolysis--skin disease contributes disproportionally to disease burden in terms of personal and psychosocial wellbeing, vocational disability, and hence in medical and social costs. Since several manifestations are closely associated with the presence and activity of systemic lupus erythematosus, prompt and accurate diagnosis of cutaneous lupus erythematosus is essential. This review aims to cover common, rare, and atypical manifestations of lupus erythematosus-associated skin disease with a detailed discussion of histopathological correlates. Cutaneous lupus erythematosus covers a wide morphological spectrum well beyond acute, subacute and chronic cutaneous lupus erythematosus, which are commonly classified as lupus-specific skin disease. Other uncommon or less well-known manifestations include lupus erythematosus tumidus, lupus profundus, chilblain lupus, mucosal lupus erythematosus, and bullous lupus erythematosus. Vascular manifestations include leukocytoclastic and urticarial vasculitis, livedoid vasculopathy and livedo reticularis/ racemosa. Finally, we discuss rare presentations such as lupus erythematosus-related erythema exsudativum multiforme (Rowell syndrome), Kikuchi-Fujimoto disease, extravascular necrotizing palisaded granulomatous dermatitis (Winkelmann granuloma), and neutrophilic urticarial dermatosis.
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Affiliation(s)
- G Obermoser
- Baylor Institute for Immunology Research, Dallas, TX, USA.
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Abstract
Cutaneous lupus erythematosus (LE) may present in a variety of clinical forms. Three recognized subtypes of cutaneous LE are acute cutaneous LE (ACLE), subacute cutaneous LE (SCLE), and chronic cutaneous LE (CCLE). ACLE may be localized (most often as a malar or 'butterfly' rash) or generalized. Multisystem involvement as a component of systemic LE (SLE) is common, with prominent musculoskeletal symptoms. SCLE is highly photosensitive, with predominant distribution on the upper back, shoulders, neck, and anterior chest. SCLE is frequently associated with positive anti-Ro antibodies and may be induced by a variety of medications. Classic discoid LE is the most common form of CCLE, with indurated scaly plaques on the scalp, face, and ears, with characteristic scarring and pigmentary change. Less common forms of CCLE include hyperkeratotic LE, lupus tumidus, lupus profundus, and chilblain lupus. Common cutaneous disease associated with, but not specific for, LE includes vasculitis, livedo reticularis, alopecia, digital manifestations such as periungual telangiectasia and Raynaud phenomenon, photosensitivity, and bullous lesions. The clinical presentation of each of these forms, their diagnosis, and the inter-relationships between cutaneous LE and SLE are discussed. Common systemic findings in SLE are reviewed, as are diagnostic strategies, including histopathology, immunopathology, serology, and other laboratory findings. Treatments for cutaneous LE initially include preventive (e.g. photoprotective) strategies and topical therapies (corticosteroids and topical calcineurin inhibitors). For skin disease not controlled with these interventions, oral antimalarial agents (most commonly hydroxychloroquine) are often beneficial. Additional systemic therapies may be subdivided into conventional treatments (including corticosteroids, methotrexate, thalidomide, retinoids, dapsone, and azathioprine) and newer immunomodulatory therapies (including efalizumab, anti-tumor necrosis factor agents, intravenous immunoglobulin, and rituximab). We review evidence for the use of these medications in the treatment of cutaneous LE.
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Affiliation(s)
- Hobart W Walling
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA
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Bae YI, Yun SJ, Lee JB, Kim SJ, Won YH, Lee SC. A clinical and epidemiological study of lupus erythematosus at a tertiary referral dermatology clinic in Korea. Lupus 2009; 18:1320-6. [PMID: 19884217 DOI: 10.1177/0961203309345769] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dermatological examination is critical for the evaluation of lupus erythematosus. However, little is known about the epidemiology and clinical characteristics of the lupus erythematosus patients that visit dermatology clinics with the chief complaint of skin lesions, especially among Asian populations. We performed this study to determine the epidemiology of cutaneous lupus erythematosus for three subtypes: acute cutaneous lupus erythematosus, subacute cutaneous lupus erythematosus, and chronic cutaneous lupus erythematosus, and for lupus erythematosus non-specific skin disease. Also, we sought to determine the relationship between each type of lupus erythematosus, by the skin manifestations and systemic lupus erythematosus. The medical records of lupus erythematosus patients that were diagnosed by their clinical manifestations, skin biopsy results, and laboratory findings from January 1998 through December 2007 were reviewed. A total of 117 patients were diagnosed with lupus erythematosus; 62 cases had chronic cutaneous lupus erythematosus, 11 had subacute cutaneous lupus erythematosus, and 41 had acute cutaneous lupus erythematosus. The remaining three had systemic lupus erythematosus features with lupus erythematosus non-specific skin lesions such as Raynaud phenomenon, livedo reticularis/vasculitis, non-scarring alopecia, and periungual telangiectasia. The acute cutaneous lupus erythematosus subgroup showed extreme female predominance (9.2:1) whereas subacute and chronic cutaneous lupus erythematosus subgroups did not. Patients with chronic cutaneous lupus erythematosus tended to be older than other groups (peak incidence in the fifth decade). Incidence of laboratory abnormalities, including positive connective tissue markers such as antinuclear, double-strand DNA, and Ro/SS-A antibodies, were present in the order acute, subacute, and chronic cutaneous lupus erythematosus. Acute cutaneous lupus erythematosus almost always indicated systemic involvement of lupus erythematosus, whereas chronic cutaneous lupus erythematosus did not predict the development or existence of systemic lupus erythematosus and had a benign clinical course. Careful consideration of lupus erythematosus non-specific skin lesions may help detect systemic lupus erythematosus regardless of the diagnosis of cutaneous lupus erythematosus.
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Affiliation(s)
- Y I Bae
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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Khorvash F, Naeini AE, Behjati M, Karimifar M, Khorvash F, Dialami K. Rapidly evolving purpuric lesions to massive hemorrhagic bullae, with rapid improvement by Prednisolone: as a coetaneous manifestation of Systemic Lupus Erythematosus: a case report. CASES JOURNAL 2008; 1:79. [PMID: 18691404 PMCID: PMC2526068 DOI: 10.1186/1757-1626-1-79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2008] [Accepted: 08/08/2008] [Indexed: 12/04/2022]
Abstract
Background Systemic lupus Erythematosus is a chronic autodestructive disease, with loss of immune tolerance to nucleic acid and other cross reactive antigens. Despite of the numerous studies, the presence of some new manifestations indicates the greater proportion of unknown data. Case presentation Our case, is a 26-year-old female, by the chief complaint of headache, vomiting, fever and arthralgia. Some hemorrhagic ulcers in her mouth with fulminant pethechia/purpura on her limbs and buttocks were prominent. On admission, she was in hypotensive state. By the clinical suspicion to meningococcal septicemia, lumbar puncture was performed, and antibiotic therapy was started. Cerebrospinal fluid was normal. Suddenly, on the 3rd day of admission, hemorrhagic bullae were evolved from those purpuric lesions. Leukocytosis, immune hemolytic anemia, thrombocytopenia and high antinuclear antibody/double stranded DNA level and hypocomplemania were present simultaneously. In skin biopsy, immune complex deposition in dermoepidermal junction was seen. The diagnosis of Systemic lupus Erythematosus was made. The patient responded well to corticosteroid therapy. Conclusion Coetaneous manifestations are very common in Systemic lupus Erythematosus, and help the physician making differential diagnoses and proper diagnosis. The rapidly evolving hemorrhagic bulla from primary purpuric lesions, with rapid response to Prednisolone, is a rare manifestation of Systemic lupus Erythematosus, which should be considered in such a disease setting.
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Patzelt A, Knorr F, Blume-Peytavi U, Sterry W, Lademann J. Hair follicles, their disorders and their opportunities. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.ddmec.2008.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Brodell LA, Beck LA. Differential diagnosis of chronic urticaria. Ann Allergy Asthma Immunol 2008; 100:181-8; quiz 188-90, 215. [PMID: 18426134 DOI: 10.1016/s1081-1206(10)60438-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To review diseases that can present with cutaneous signs and symptoms that mimic those observed in chronic urticaria and to discuss the workup necessary to distinguish these diseases from chronic urticaria. DATA SOURCES We performed a PubMed search using the following keywords: urticaria, cryopyrin, Sweet syndrome, subacute cutaneous lupus, urticarial vasculitis, urticaria pigmentosa, angioedema, fixed drug eruption, bullous pemphigoid, and reticular erythematous mucinosis. Appropriate chapters in general dermatology textbooks were also reviewed. STUDY SELECTION Articles that related to disease states, which present with persistent urticarial lesions, were catalogued for use in this review. RESULTS Besides acute, chronic, and physical urticarias, there are 2 categories of diseases that have urticarial lesions. The first group includes those in which the skin lesions are almost indistinguishable from those seen in patients with chronic idiopathic urticaria. Thus, the diagnosis relies on a careful history and physical examination, and in some cases laboratory studies are required. The second group are ones that have skin lesions that at one point in their development have an urticaria-like appearance or on rare occasion may have such lesions. These latter diseases are numerous, and we have tried to highlight the ones that most mimic chronic idiopathic urticaria or are more common. CONCLUSIONS A working knowledge of the diseases that can present with urticarial lesions is essential to accurately diagnose and effectively treat these symptomatic and sometimes serious conditions.
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Affiliation(s)
- Lindsey A Brodell
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA
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Krathen MS, Dunham J, Gaines E, Junkins-Hopkins J, Kim E, Kolasinski SL, Kovarik C, Kwan-Morley J, Okawa J, Propert K, Rogers N, Rose M, Thomas P, Troxel AB, Van Voorhees A, Feldt JV, Weber AL, Werth VP. The Cutaneous Lupus Erythematosus Disease Activity and Severity Index: expansion for rheumatology and dermatology. ACTA ACUST UNITED AC 2008; 59:338-44. [PMID: 18311759 DOI: 10.1002/art.23319] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) for use by rheumatologists via reliability testing, and to extend the validation for dermatologists. METHODS Fourteen subjects with cutaneous lupus erythematosus (CLE; n = 10), a mimicker skin disease only (a cutaneous lesion that may appear clinically similar to CLE; n = 1), or both (n = 3) were rated with the CLASI by academic-based dermatologists (n = 5) and rheumatologists (n = 5). RESULTS The dermatology intraclass correlation coefficient (ICC) was 0.92 for activity and 0.82 for damage; for rheumatology the ICC was 0.83 for activity and 0.86 for damage. For intrarater reliability, the dermatology Spearman's rho was 0.94 for activity and 0.97 for damage; for rheumatology the Spearman's rho was 0.91 for activity and 0.99 for damage. CONCLUSION Our data confirm the reliability of the CLASI when used by dermatologists and support the CLASI as a reliable instrument for use by rheumatologists.
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Affiliation(s)
- M S Krathen
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Fernando MMA, Isenberg DA. Conversion of discoid lupus to antiphospholipid syndrome and SLE. ACTA ACUST UNITED AC 2008; 4:106-10. [PMID: 18235540 DOI: 10.1038/ncprheum0704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 10/30/2007] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 64-year-old man was admitted to hospital with increasing seizure frequency, lethargy and confusion. He had a history of discoid lupus erythematosus, complex partial seizures, cerebral thromboses associated with antiphospholipid syndrome (APS) and hypertension. After admission to hospital, he developed autoimmune hemolytic anemia, thrombocytopenia, severe hypertension, proteinuria and a fluctuating level of consciousness. INVESTIGATIONS Physical examination, biochemical and hematological indices, urine dipstick, electrocardiography and chest radiography on admission, with subsequent electroencephalography, lumbar puncture, septic screen, autoimmune screen, CT of the head, MRI of the brain and renal biopsy. DIAGNOSIS Conversion of discoid lupus erythematosus with APS to systemic lupus erythematosus with APS. MANAGEMENT Pulsed intravenous methylprednisolone and a single infusion of intravenous cyclophosphamide, followed by oral prednisolone, were initially administered for presumed cerebral lupus. When renal biopsy revealed dual pathology, another dose of intravenous cyclophosphamide was administered with intravenous heparin therapy to treat systemic lupus erythematosus and APS, respectively. Intravenous immunoglobulin was used to treat thrombocytopenia, which was unresponsive to immunosuppression and anticoagulation. Gradual improvement occurred with maximal antihypertensive therapy and supportive treatment. The patient was discharged after 9 months of hospital treatment. His medication at this stage included warfarin, clopidogrel, prednisolone, carbamazepine, ramipril, atenolol, calcium and vitamin D supplements, and alendronate.
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Affiliation(s)
- Michelle M A Fernando
- Section of Molecular Genetics and Rheumatology, Faculty of Medicine, Imperial College, London, UK
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Mseddi M, Dammak A, Marrekchi S, Bouassida S, Zahaf A, Turki H. Lupus érythémateux subaigu de l'enfant: à propos d'un cas. Arch Pediatr 2007; 14:164-6. [PMID: 17207613 DOI: 10.1016/j.arcped.2006.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 10/25/2006] [Indexed: 11/25/2022]
Abstract
Subacute cutaneous lupus erythematosus is extremely rare in childhood. We report the case of a 7 year-old girl who presented annular erythematous infiltrated lesions on sun exposed areas since the age of 2 months. Histopathologic examination showed orthohyperkeratosis, epidermal atrophy, widespread hydropic degeneration of epidermal basal cell layer, and a dermal lymphohistiocytic infiltrate. The lupus band test was negative. The immunological investigations (antinuclear antibodies) were negative. Treatment with antimalarials, topical steroids and sun protection allowed clearance of the cutaneous lesions. Lesions relapsed after antimalarials discontinuation and sun exposure. Four years later, at the age of 11, the antinuclear antibodies became positive. The diagnosis of subacute cutaneous lupus erythematosus is based on the clinical aspect of lesions, topography, histological finding, evolution and immunological profile of the patient.
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Affiliation(s)
- M Mseddi
- Service de dermatologie, EPS Hédi-Chaker de Sfax, Tunisie.
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Brunner J, Sergi C, Jungraithmayr T, Zimmerhackl LB. Systemischer Lupus erythematodes im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2006. [DOI: 10.1007/s00112-006-1400-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tlacuilo-Parra A, Guevara-Gutiérrez E, Gutiérrez-Murillo F, Soto-Ortiz A, Barba-Gómez F, Hernández-Torres M, Salazar-Páramo M. Pimecrolimus 1% cream for the treatment of discoid lupus erythematosus. Rheumatology (Oxford) 2005; 44:1564-8. [PMID: 16159951 DOI: 10.1093/rheumatology/kei093] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the safety and efficacy of pimecrolimus cream on lesions of discoid lupus erythematosus. METHODS In an open-label phase II trial, patients with discoid lupus were treated with pimecrolimus 1% cream twice daily for 8 weeks. We assessed skin involvement with a clinical severity score, quality of life, patient improvement and toxicity. The changes were documented by skin biopsy at baseline and at the end of treatment. RESULTS Ten patients with a mean age of 34 +/- 17 yr and disease duration of 3 yr (range 1-8) were studied; 90% were female and 40% had received prior topical or systemic therapy without response. In all patients, improvement of skin damage was observed after therapy. A significant decrease of 52% was observed in the mean +/- s.d. clinical severity score, from 6.1 +/- 1.4 before treatment to 2.9 +/- 1.5 after treatment (P = 0.005). Quality of life score (0 = no effect, 100 = maximum effect on quality of life) showed a mean improvement of 46%, from 42.8 +/- 23.1 before to 23 +/- 16.5 after treatment (P = 0.008). According to the patients' assessment of the response to treatment, 50% qualified as marked improvement, 40% moderate and 10% slight improvement. The treatment was well tolerated; adverse reactions consisted of minimal erythema and pruritus, which resolved without any further action. CONCLUSIONS Our data suggest that pimecrolimus cream for discoid lupus erythematosus seems to be a safe and clinically effective option. However, this was an open and uncontrolled study, and double-blind, placebo-controlled studies are needed.
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Affiliation(s)
- A Tlacuilo-Parra
- Medical Research Division, UMAE, Hospital de Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México.
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